CPT code 77085 is for a DXA bone density study, a test that measures bone strength and helps diagnose conditions like osteoporosis.
CPT code 77085 is used for a DXA (Dual-Energy X-ray Absorptiometry) bone density study that includes a vertebral fracture assessment. This procedure is a specialized imaging test that measures bone mineral density to assess the strength of bones and the risk of fractures. The inclusion of vertebral fracture assessment means that the test not only evaluates bone density but also checks for any fractures in the vertebrae, providing a comprehensive overview of bone health. This code is typically used by healthcare providers to document and bill for this specific diagnostic service.
For the CPT codes provided, here is a list of potential modifiers that could be applicable, along with the reasons for their use:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It is applicable if the healthcare provider is only interpreting the results of the imaging or study, rather than performing the technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It applies if the provider is responsible for the equipment, supplies, and technical staff involved in the procedure, but not the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is applicable if the imaging or study is performed in a separate session or is not typically performed together with other procedures.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): This modifier is used when a clinical diagnostic test is repeated on the same day to obtain subsequent test results. It is applicable if the bone density study or imaging needs to be repeated for clinical reasons.
7. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service provided. It is applicable if multiple modifiers are required to accurately represent the service performed.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It is important to verify payer-specific guidelines, as the applicability of modifiers can vary.
CPT code 77085 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined by the Medicare Physician Fee Schedule (MPFS).
The MPFS provides the payment rates for services covered under Medicare Part B, including CPT code 77085. However, the actual reimbursement amount can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC).
Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much Medicare reimburses for CPT code 77085 in different regions.
Healthcare providers should consult their specific MAC for detailed information on coverage criteria and reimbursement rates for this code.
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